Extended patellofemoral

ABSTRACT

Disclosed herein are knee replacement systems for replacing the articular surface of a distal femur. The systems include one or more unicompartmental components, namely patellofemoral, lateral condylar and medial condylar components. The components are configured such that when engaged to the femur the peripheries thereof do not cross specific locations and/or regions of the femur, namely the intercondylar notch and condylopatellar notch. The patellofemoral components described herein preferably have an extension portion extending posteriorly from a posterior periphery thereof towards an intercondylar notch or the femur without contacting the intercondylar notch of the femur when the patellofemoral component is engaged to the femur. The extension portion preferably extends posteriorly from a posterior periphery of the patellofemoral component towards the condylopatellar notch of the femur without contacting the notch.

FIELD OF THE INVENTION

The present invention relates to patellofemoral implants and inparticular relates to such implants having an extension portion designedto cover the medial and/or lateral aspect of the patellofemoralcompartment posteriorly up to the intercondylar notch andcondylopatellar notch.

BACKGROUND OF THE INVENTION

The knee joint includes three bones, namely the femur, tibia andpatella. The distal end of the femur lies adjacent to the proximal endof the tibia while the patella lies adjacent the anterior portion of thefemur. The joint elements that engage one another are preferably coveredby articular cartilage. Specifically, the distal end of the femur andthe proximal end of the tibia are covered by articular cartilage, as isthe posterior surface of the patella.

The articular cartilage of the knee joint may become damaged due todegeneration and/or wear, which may lead to bone-to-bone contact duringarticulation of the joint. This may result in significant pain andpotential damage to the bone surfaces. A knee replacement procedure maybe required in cases where damage to the articular cartilage issignificant. Depending on the extent of the damage, the procedure mayinclude at least partial replacement of one or bone of the knee joint.For instance, in a total knee replacement each of the bones of the kneejoint is at least partially covered by implants. In other instances, aknee arthroplasty procedure may be limited to portions of one of thejoints. For instance, a patellofemoral procedure is limited to at leastpartial replacement of the engagement surfaces between the femur and thepatella.

The medial and lateral condylopatellar notches represent a borderbetween the patellofemoral and tibiofemoral articulations of the distalfemur. The condylopatellar notch is a concave depression formed betweenthe patellofemoral compartment and the medial and lateral compartmentsrespectively. The concave depression is formed at least in part due tofemoral contact with the tibial meniscus when the leg is extended. Thegeometry of the concave depression is in contrast to the convexgeometries of the adjacent compartments. The sulcus of thecondylopatellar notch forms a spline that represents a transition regionor functional boarder between the compartments of the knee. This splinecan be simplified to a best-fit line which substantially describes thelocation and trajectory of the border.

Conventional patellofemoral implants typically cover the femoraltrochlea only and generally require that a lateral tibiofemoralcomponent, for example, extend past the condylopatellar notch into thepatellofemoral compartment. In the case where no lateral tibiofemoralimplant is implanted, a surgeon must carefully plan the transitionbetween the patellofemoral implant and the native cartilage. In suchcases, it is expected that the patella will frequently transition fromthe patellofemoral component to the native condylar cartilage duringactive and deep flexion.

BRIEF SUMMARY OF THE INVENTION

The patellofemoral implants of the present invention improve implantcoverage of each compartment of the distal femur for a larger percentageof the population. By designing the implants to only cover the regioninside the condylopatellar border, anatomical variability reduces andless implant sizes and shapes are required to cover more people.Extension of the lateral flange of the implants helps to ensure that thepatella remains in contact with the implants instead of stepping off theimplants when transitioning to native cartilage laterally of the distalfemur, medial cartilage or a medial unicompartmental implant.

A first aspect of the present invention is a patellofemoralunicompartmental implant with a posterior periphery that extendsposteriorly toward the medial and/or lateral condylopatellar notchwithout crossing the notch. Such a patellofemoral implant may be used asa stand-alone device or in conjunction with a medial and/or lateraltibiofemoral unicompartmental implant each having an anterior peripherythat extends anteriorly toward the respective medial and/or lateralcondylopatellar notch without crossing the respective notch.

One embodiment of this first aspect is that the patellofemoral implantpreferably replaces the articular cartilage and bone in thepatellofemoral compartment. A lateral aspect of the implant is designedto cover a lateral aspect of the patellofemoral compartment posteriorlyup to the condylopatellar notch and above the intercondylar notchwithout crossing the condylopatellar notch or contacting theintercondylar notch.

A second aspect of the present invention is a patellofemoral componentfor replacing at least a portion of a femur comprising a lateral portionconfigured to cover at least a portion of the femur, an intermediateportion adjacent to the lateral portion and configured to cover at leasta portion of a length of a trochlear groove of the femur, and a medialportion adjacent to the intermediate portion and configured to cover atleast a portion of the femur. The patellofemoral components include anextension portion extending posteriorly from the intermediate portiontowards an intercondylar notch of the femur without contacting theintercondylar notch of the femur when the patellofemoral component isengaged to the femur.

In one embodiment of this second aspect the extension portion extendsposteriorly from the lateral portion and the intermediate portion.

In another embodiment, the extension portion extends along at least aportion of a condylopatellar notch of the femur and substantiallyparallel to the condylopatellar notch without contacting the notch.

In yet another embodiment, the medial portion covers at least a portionof an anterior portion of a medal condyle of the femur withoutcontacting the condylopatellar notch and the extension portion covers atleast a portion of a posterior portion of a lateral condyle of the femurwithout contacting the condylopatellar notch.

In still yet another embodiment, the lateral portion has a firstposterior periphery, the intermediate portion has a second posteriorperiphery, the medial portion has a third posterior periphery, and theextension portion is located at a junction between the first and secondposterior peripheries. The extension portion may protrude posteriorlyfrom the junction as a nub portion. The extention portion may protrudeposteriorly from the junction along a substantial portion of the firstposterior periphery.

A third aspect of the present invention is a knee replacement system forreplacing at least a portion of a femur comprising a patellofemoralcomponent including an extension portion extending posteriorly from aposterior periphery thereof towards an intercondylar notch of the femurwithout contacting the intercondylar notch of the femur when thepatellofemoral component is engaged to the femur, and a condylar implantincluding a recessed portion opposed to the extension portion of thepatellofemoral component when the condylar portion is engaged to acondyle of the femur, the recessed portion located adjacent theintercondylar notch of the femur without contacting the intercondylarnotch.

In one embodiment of this third aspect, the patellofemoral componentincludes a lateral portion configured to cover at least a portion of thefemur.

In another embodiment, the patellofemoral component includes anintermediate portion connected to the lateral portion configured tocover at least a portion of a length of a trochlear groove of the femur.The patellofemoral component further includes a medial portion connectedto the intermediate portion configured to cover at least a portion ofthe femur.

In yet another embodiment, the extension portion extends posteriorlyfrom the intermediate portion towards a condylopatellar notch of thefemur without contacting the notch.

In still yet another embodiment, the lateral portion has a firstposterior periphery, the intermediate portion has a second posteriorperiphery, the medial portion has a third posterior periphery, and theextension portion is located at a junction between the first and secondposterior peripheres. The extension portion may protrude posteriorlyfrom the junction as a nub portion. The extention portion may protrudeposteriorly from, the junction along a substantial portion of the firstposterior periphery.

A fourth aspect of the present invention is a knee replacement systemfor replacing at least a portion of a femur comprising a patellofemoralcomponent including an extension portion configured to overlie a portionof a lateral condyle of the femur above an intercondylar notch of thefemur without contacting the intercondylar notch of the femur when thepatellofemoral implant is engaged to the femur, and a condylar implantincluding a recessed portion opposed to the extension portion of thepatellofemoral component when the condylar portion is engaged to acondyle of the femur, the recessed portion located anteriorly to acondylopatellar notch of the femur.

In one embodiment of this aspect, the extension portion extendsposteriorly from a posterior periphery of the patellofemoral componenttowards the condylopatellar notch of the femur without contacting thenotch.

In another embodiment, the patellofemoral component includes a lateralportion having a first posterior periphery, an intermediate portionhaving a second posterior periphery, a medial portion having a thirdposterior periphery, and the extension portion is located at a junctionbetween the first and second posterior peripheries. The extensionportion may protrude posteriorly from the junction as a nub portion. Theextention portion may protrude posteriorly from the junction along asubstantial portion of the first posterior periphery.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete appreciation of the subject matter of the presentinvention and the various advantages thereof can be realized byreference to the following detailed description in which reference ismade to the accompanying drawings in which:

FIG. 1 is a topographic isometric view of a left femur.

FIG. 2 is a topographic distal view of a distal end of the left femurshown in FIG. 1.

FIG. 3A is topographic distal view of a traditional patellofemoralimplant engaged to the distal end of the left femur shown in FIG. 1.

FIG. 3B is a topographic distal view of the traditional patellofemoralimplant shown in FIG. 3 and a traditional lateral condylar implant eachengaged to the distal end of the left femur shown in FIG. 1.

FIG. 3C is a topographic distal view of the traditional patellofemoralimplant shown in FIG. 3 and a traditional medial condylar implant eachengaged to the distal end of the left femur shown in FIG. 1.

FIG. 4 is a topographic distal view of the traditional patellofemoralimplant shown in FIG. 3A and traditional lateral and medial and condylarimplants shown in FIGS. 3B and 3C respectively each engaged to thedistal end of the left femur shown in FIG. 1.

FIG. 5 is another topographic distal view of a distal end of a leftfemur showing the location of an intercondylar notch and a lateralcondylopatellar notch line thereof.

FIG. 6 is another topographic distal view of a distal end of a leftfemur showing the location of an intercondylar notch and a medialcondylopatellar notch line thereof.

FIG. 7A is an isometric view of one embodiment of a patellofemoralimplant having a first-type extension portion.

FIG. 7B is a distal view of the patellofemoral implant of FIG. 7A.

FIG. 7C is a medial view of the patellofemoral implant of FIG. 7A.

FIG. 8A is an isometric view of one embodiment of a patellofemoralimplant having a second-type extension portion.

FIG. 8B is a distal view of the patellofemoral implant of FIG. 8A.

FIG. 8C is a medial view of the patellofemoral implant of FIG. 8A.

FIG. 9A is a topographic distal view of the patellofemoral implant shownin FIGS. 7A-7C each engaged to the distal end of the left femur shown inFIG. 1.

FIG. 9B is a topographic distal view of the patellofemoral implant shownin FIGS. 8A-8C each engaged to the distal end of the left femur shown inFIG. 1.

FIG. 10A is a topographic distal view of the patellofemoral implantshown in FIGS. 7A-7C and one embodiment of a first-type truncatedlateral condylar implant each engaged to the distal end of the leftfemur shown in FIG. 1.

FIG. 10B is a topographic distal view of the patellofemoral implantshown in FIGS. 8A-8C and one embodiment of a second-type truncatedlateral condylar implant each engaged to the distal end of the leftfemur shown in FIG. 1.

FIG. 11A is a topographic distal view of the patellofemoral implantshown in FIGS. 7A-7C and one embodiment of a medial condylar implanteach engaged to the distal end of the left femur shown in FIG. 1.

FIG. 11B is a topographic distal view of the patellofemoral implantshown in FIGS. 8A-8C and one embodiment of a medial condylar implanteach engaged to the distal end of the left femur shown in FIG. 1.

FIG. 12A is a topographic distal view of the patellofemoral implantshown in FIGS. 7A-7C, the first-type truncated lateral condylar implantshown in FIG. 10A, and the medial condylar implant shown in FIGS.11A-11B each engaged to the distal end of the left femur shown in FIG.1.

FIG. 12B is a topographic distal view of the patellofemoral implantshown in FIGS. 8A-8C, the second-type truncated lateral condylar implantshown in FIG. 10B, and the medial condylar implant shown in FIGS.11A-11B each engaged to the distal end of the left femur shown in FIG.1.

DETAILED DESCRIPTION

Referring to the drawings, wherein like reference numerals representlike elements, there is shown in the figures, in accordance withembodiments of the present invention, patellofemoral and condylarimplants engaged to a resected distal end 12 of a femur, designatedgenerally by reference numeral 10. FIGS. 1-2A are topographic isometricand distal views respectively of distal end 12 of femur 10 showing thecontour of the outer surface thereof. As can be seen from these figures,femur 10 is a left femur having three regions, namely the trochleargroove 14, lateral condyle 16, and medial condyle 18. The topography ofthese areas or regions is referenced generally by the varying linecurvature thereof.

FIG. 3A is topographic distal view of a traditional patellofemoralimplant 100 engaged to the distal end of the left femur shown in FIG. 1.Implant 100 includes an articular surface 102 having an outer periphery104 and a trochlear groove 106, for example. Prior to being engaged tothe distal end 12 of the left femur 10 shown in FIG. 1, the distal end12 of femur 10 may be resected either by standard or custominstrumentation, including guides and reamers, for example. Once engagedto distal end 12 of femur 10, articular surface 102 of implant 100 isgenerally located where the outer surface of the articular cartilage ofthe distal femur was located prior to any degeneration or wear thereof.Surgeon preference however may be to alter the location of articularsurface 102 of implant 100 once engaged to distal end 12 of femur 10such that it is not located exactly where the outer surface of thearticular cartilage of the distal femur was located prior to anydegeneration of wear thereof.

Outer periphery 104 of implant 100 includes medial and lateral recesses108, 110 located adjacent the medial and lateral aspect of thepatellofemoral compartment and above or anterior to the condylopatellarnotch line. These recesses 108, 110 provide adequate clearance for atraditional lateral condylar implant 120 and/or medial condylar implant140 engaged to the distal end of the left femur as shown in FIGS. 3B and3C. Each of lateral and medial condylar implants 120, 140 includearticular surfaces 122, 142 and outer peripheries 124, 144,respectively. An anterior portion 126, 146 of lateral and medialcondylar implants 120, 140, respectively, lie substantially adjacent torecesses 110, 108 of implant 100 respectively, as shown in FIG. 6, forexample.

FIGS. 5 and 6 are other topographic distal views of a distal end of aleft femur showing the location of an intercondylar notch 20 and lateraland medial condylopatellar notch lines 21, 27 respectively thereof.Intercondylar notch 20 is referenced as a point located in trochleargroove region 14.

As shown in FIG. 5, lateral condylopatellar notch line 21 extends acrosslateral condyle 16 and intersects sagittal plane 22 at intersectionpoint 23. A posterior distance D1 is defined as the distance betweenintercondylar notch 20 and intersection point 23 along sagittal plane22. An angle θ1 is the measurement of the acute internal/externalrotational angle between condylopatellar notch line 21 and flexion axis24 of the knee.

As shown in FIG. 6, medial condylopatellar notch line 27 extends acrossmedial condyle 18 and intersects sagittal plane 22 at intersection point23. A posterior distance D2 is defined as the distance betweenintercondylar notch 20 and intersection point 23 along sagittal plane22. An angle θ2 is the measurement of the acute internal/externalrotational angle between condylopatellar notch line 27 and flexion axis24 of the knee.

A morphological analysis of 921 computed tomography (“CT”) scans showsthat there is a 95% likelihood that lines 21, 27 representing thelateral and medial condylopatellar notch lines, respectively, lie inboundaries 25, 28, respectively as shown in the triangular shadedregions of FIGS. 5 and 6, respectively. According to the morphologicalanalysis, the mean posterior distance D1 is 6.4 mm with a ±1.25 mmvariation as depicted by boundary 25. The mean posterior distance D2 is2.9 mm with a ±1.20 mm variation as depicted by boundary 28. Further tothe analysis, the mean angle θ1 is 22.7° with ±5.7° variation asdepicted by boundary 25 and the mean angle θ2 is 47.1° with ±5.43°variation as depicted by boundary 28.

The morphological analysis described above is one method ofcharacterizing the condylopatellar notch in one specified demographic.The three dimensional curvature of the condylopatellar notch issimplified here as being represented as a line. This analysis could bemodified to represent the region as a series of arcs or a point fieldwhich may alter the shape and extents of the 95% likelihood region. Thisanalysis could also be modified to look at specific demographics such asgenders, ethnicities, and sizing measures, for example, to designimplants for those groups. The analysis could be used to describe thenotch over a large population to characterize a broad average shape. Inany of these cases, the bounding region would then be used to define theextents of the implant extension/truncation to avoid crossing the notch.The shape of the bounding region could also be used to shape theperipheries of the implant where it approaches the notch.

FIGS. 7A-7C show a first embodiment of a patellofemoral implant 200having a first-type extension portion 260 and FIGS. 8A-8C show a secondembodiment of a patellofemoral implant 300 having a second-typeextension portion 360.

As shown in FIGS. 7A-7C, implant 200 includes a bone contacting surface201, an articular surface 202 having an outer periphery 204 and atrochlear groove 206, for example. Implant 200 further includes a firstcondylar portion 210 configured to cover at least a portion of lateralcondyle 16 of femur 10, an intermediate portion 220 adjacent to firstcondylar portion 210 configured to cover at least a portion of a lengthof trochlear groove 14 of femur 10, and a second condylar portion 230adjacent to intermediate portion 220 configured to cover at least aportion of medial condyle 18 of femur 10. First condylar portion 210 hasa first periphery 212, intermediate portion 220 has a second periphery222 forming a recess and second condylar portion 230 has a thirdperiphery 232.

Outer periphery 204 of implant 200 differs from outer periphery 104 ofimplant 100 in that outer periphery 204 of implant 200 includes anextension portion 260 having a first configuration projectingposteriorly from a posterior portion thereof. Extension portion 260 isdesigned to cover at least a portion of a lateral aspect of thepatellofemoral compartment posteriorly up to intercondylar notch 20 andcondylopatellar notch line 21 of femur 10 when implant 200 is engaged todistal end 12 of femur 10 as shown in FIG. 9A. Extension portion 260 hasa substantially planar periphery and is located intermediate first andsecond peripheries 212, 222. The periphery of extension portion 260 liesadjacent along a length of condylopatellar notch line 21 of femur 10without crossing condylopatellar notch line 21. In this embodiment, thesubstantially planar periphery of extension portion 260 is substantiallyperpendicularly oriented to first periphery 212 of first condylarportion 210.

As shown in FIGS. 8A-8C, implant 300 includes a bone contacting surface301, an articular surface 302 having an outer periphery 304 and atrochlear groove 306, for example. Implant 300 further includes a firstcondylar portion 310 configured to cover at least a portion of lateralcondyle 16 of femur 10, an intermediate portion 320 adjacent to firstcondylar portion 310 configured to cover at least a portion of a lengthof trochlear groove 14 of femur 10, and a second condylar portion 330adjacent to intermediate portion 320 configured to cover at least aportion of medial condyle 18 of femur 10. First condylar portion 310 hasa first periphery 312, intermediate portion 320 has a second periphery322 forming a recess and second condylar portion 330 has a thirdperiphery 332.

Outer periphery 304 of implant 300 differs from outer periphery 104 ofimplant 100 in that outer periphery 304 of implant 300 includes anextension portion 360 having a second configuration projectingposteriorly from a posterior portion thereof. Extension portion 360 isdesigned to cover at least a portion of a lateral aspect of thepatellofemoral compartment posteriorly up to intercondylar notch 20 andcondylopatellar notch line 21 of femur 10 when implant 300 is engaged todistal end 12 of femur 10 as shown in FIG. 9B. Extension portion 360 hasa substantially planar periphery and is located intermediate first andsecond peripheries 312, 322. The periphery of extension portion 360 liesmost adjacent to condylopatellar notch line 21 of femur 10 atintermediate portion 320. In this embodiment, the substantially planarperiphery of extension portion 360 is transverse to first periphery 312of first condylar portion 310.

The geometry of extension portions 260, 360 of patellofemoral implants200, 300, respectively, allows more contact with the patella throughactive flexion than occurs with traditional patellofemoral implants suchas implant 100 shown in FIG. 3, for example. Active flexion occurs atapproximately 10-110 degrees between the tibial and femoral mechanicalaxes with deep flexion occurring beyond 110 degrees and up toapproximately 150 degrees. The geometry of extension portions 260, 360of patellofemoral implants 200, 300, respectively, also accounts forunicondylar implants with truncated geometry to accommodatepatellofemoral implants 200, 300 and to stay out of contact with patellain active flexion. Such unicondylar implants 400, 500 with truncatedgeometry are shown in FIGS. 10A and 10B, respectively.

FIGS. 11A and 11B show patellofemoral implants 200, 300 and medialcondylar implants 600, 700 respectively each engaged to distal end 12 offemur 10. FIGS. 12A and 12B show patellofemoral implants 200, 300,truncated unicondylar implants 400, 500 and medial condylar implants 700respectively each engaged to distal end 12 of femur 10.

Without extension portions 260, 360 on patellofemoral implants 200, 300the patella will frequently transition off and on patellofemoralimplants 200, 300 during active flexion increasing the likelihood offailure if implantation is not ideal and implant materials are not wellmatched. A traditional patellofemoral implant such as implant 100 doesnot allow a lateral tibiofemoral implant such as implant 120 to betruncated without increasing the distance over which the patella mustarticulate with native cartilage, for example. While an extended lateraltibiofemoral component may be thought of as a solution to this problem,such an implant can be challenging to fit on many patients due to therelative variability of the peripheries of the patellofemoral andtibiofemoral compartments on either side of the condylopatellar notch 16of a patient. Extended patellofemoral implants 200, 300 increases thelength of contact with the patella during active flexion and indirectlydecreases the variability of the periphery required to be covered inboth the patellofemoral and tibiofemoral compartments.

The extension portion or posterior lateral periphery 260, 360 ofextended patellofemoral implants 200, 300, respectively, is thereforeextended to lie adjacent to condylopatellar notch line without crossingthe condylopatellar notch line 21. The anterior peripheries 460, 560 ofthe matched lateral tibiofemoral implants 400, 500, respectively, canthen be truncated to remain posterior of the condylopatellar notch 16 asshown in FIGS. 10A and 10B.

Extending the posterior lateral periphery 260, 360 of patellofemoralimplants 200, 300, respectively towards condylopatellar notch line 21allows for a number of advantages. The extended articular surfaces allowa patellar implant to remain in contact with the patellofemoral implantfor a greater range of active knee flexion. This increased contactlength reduces the likelihood and frequency of patella transition offthe patellofemoral implant.

In a medial and patellofemoral bicompartmental knee arthroplasty case,for example, this preferably reduces the likelihood of a patellarimplant from coming in contact with native cartilage. Decreased contactbetween native cartilage and patellar implant articular bearingmaterials reduces the likelihood of unfavorable material interactionswith native cartilage. In a tricompartmental case or a lateral andpatellofemoral bicompartmental case, for example, the increasedpatellofemoral contact length would reduce the frequency and likelihoodof patellar transition from the patellofemoral implant to the lateraltibiofemoral implant. The reduction in the number of transitions fromimplant to implant preferably aid in increasing the life of the implant.

By keeping the patellofemoral implant and lateral tibiofemoral implanton either side of the condylopatellar notch line, the potentialvariability of the implant periphery relative to patient's periphery isreduced. When either periphery of the patellofemoral or latertibiofemoral implant is required to cross this border on a patient, thatimplant is required to cover the periphery of its own compartment aswell as the periphery of the adjacent compartment.

It is assumed that the relative positions of these compartments areuncorrelated as they were forged by their respective articular pair.With uncorrelated relative compartment positions, the periphery acrossthe border can be assumed to be highly variable from patient to patient.Therefore the extension of the patellofemoral implant and truncation ofthe lateral tibiofemoral implant allow for a reduction in thevariability of the patient peripheries they are required to cover.

The extended patellofemoral implants 200, 300 and their matchedtruncated lateral tibiofemoral implant 400, 500 can be implantedconventionally or using robotic surgical assistance. Preoperativeplanning may be used as identification of the intercondylar notch andcondylopatellar notch line and determining implant size and positionrelative to these locations may require computational analysis.Conventional implantation could be similar to the Avon patellofemoralimplant manufactured by Stryker Orthopaedics, for example. Roboticimplantation would consist of preoperative planning, machining ofpatellofemoral compartment, implantation, trial reduction andcementation (if necessary). The posterior periphery of the extendedpatellofemoral implants 200, 300 may be an inlay preparation, flush withthe native cartilage, for example. The anterior periphery could be anonlay preparation, proud of the resected bone, for example.

Although the invention herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent invention. It is therefore to be understood that numerousmodifications may be made to the illustrative embodiments and that otherarrangements may be devised without departing from the spirit and scopeof the present invention as defined by the appended claims.

The invention claimed is:
 1. A patellofemoral component for replacing atleast a portion of a femur having a sagittal plane and a lateralcondylopatellar notch line transverse to the sagittal plane comprising:a lateral portion configured to cover at least a lateral portion of thefemur; an intermediate portion adjacent to the lateral portion andconfigured to cover at least a portion of a length of a trochlear grooveof the femur, the intermediate portion having a recess about a peripherythereof; a medial portion adjacent to the intermediate portion andconfigured to cover at least a medial portion of the femur, the medialportion lying adjacent both an intercondylar notch and a medialcondylopatellar notch line of the femur without contacting either of theintercondylar notch or the medial condylopatellar notch line when thepatellofemoral component is engaged to the femur; and an extensionportion extending posteriorly from the recess of the intermediateportion and along the lateral portion towards the intercondylar notchand the lateral condylopatellar notch line of the femur, the recessbeing located on the sagittal plane and a plane defined by the extensionportion intersecting the sagittal plane at a point posterior to theintercondylar notch, wherein the extension portion extending posteriorlyfrom the intermediate portion is substantially planar and lies adjacentboth the intercondylar notch and lateral condylopatellar notch line andextends substantially parallel to the lateral condylopatellar notch linewithout contacting either of the intercondylar notch or lateralcondylopatellar notch line of the femur when the patellofemoralcomponent is engaged to the femur.
 2. The patellofemoral component ofclaim 1, wherein a portion of the extension portion extends away from atleast a portion of the lateral condylopatellar notch line of the femurwithout contacting the condylopatellar notch line.
 3. The patellofemoralcomponent of claim 1, wherein the medial portion covers at least aportion of an anterior portion of a medial condyle of the femur withoutcontacting the medial condylopatellar notch line.
 4. The patellofemoralcomponent of claim 1, wherein the extension portion covers at least aportion of a posterior portion of a lateral condyle of the femur withoutcontacting the lateral condylopatellar notch line.
 5. The patellofemoralcomponent of claim 1, wherein the lateral portion has a first posteriorperiphery, the intermediate portion has a second posterior periphery,the medial portion has a third posterior periphery, and the extensionportion is at least partially located at a junction between the firstand second posterior peripheries.
 6. The patellofemoral component ofclaim 5, wherein the extension portion protrudes posteriorly from thejunction as a nub portion.
 7. The patellofemoral component of claim 5,wherein the extension portion protrudes posteriorly along a substantialportion of the first posterior periphery.
 8. The patellofemoralcomponent of claim 1, wherein the extension portion lies about a lineapproximately 23° from a flexion axis of the femur, the flexion axislying perpendicular to the sagittal plane.
 9. The patellofemoralcomponent of claim 1, wherein the extension portion lies about a lineapproximately 47° from a flexion axis of the femur, the flexion axislying perpendicular to the sagittal plane.
 10. A knee replacement systemfor replacing at least a portion of a femur having a sagittal plane andmedial and lateral condylopatellar notch lines transverse to thesagittal plane comprising: a patellofemoral component including anextension portion extending posteriorly from a recess about a peripheryof an intermediate portion and along a medial portion thereof towards anintercondylar notch and the medial condylopatellar notch line of thefemur, the extension portion extending posteriorly from the recess ofthe intermediate portion being substantially planar and lying adjacentboth the intercondylar notch and medial condylopatellar notch line andextending substantially parallel to the medial condylopatellar notchline without contacting either of the intercondylar notch or the medialcondylopatellar notch line of the femur when the patellofemoralcomponent is engaged to the femur, the patellofemoral component furtherincluding a lateral portion adjacent to the intermediate portion andconfigured to cover at least a lateral portion of the femur, the lateralportion lying adjacent both the intercondylar notch and the lateralcondylopatellar notch line without contacting either of theintercondylar notch or the lateral condylopatellar notch line of thefemur when the patellofemoral component is engaged to the femur; and acondylar implant including a recessed portion opposed to the extensionportion of the patellofemoral component when the condylar portion isengaged to a condyle of the femur, the recessed portion located adjacentthe intercondylar notch of the femur without contacting theintercondylar notch.
 11. The knee replacement system of claim 10,wherein the intermediate portion connected to the lateral portion isconfigured to cover at least a portion of a length of a trochlear grooveof the femur.
 12. The knee replacement system of claim 11, wherein themedial portion connected to the intermediate portion is configured tocover at least a medial portion of the femur.
 13. The knee replacementsystem of claim 11, wherein the lateral portion has a first posteriorperiphery, the intermediate portion has a second posterior periphery,the medial portion has a third posterior periphery, and the extensionportion is located at a junction between the first and second posteriorperipheries.
 14. The knee replacement system of claim 13, wherein theextension portion protrudes posteriorly from the junction as a nubportion.
 15. The knee replacement system of claim 13, wherein theextension portion protrudes posteriorly from the junction along asubstantial portion of the first posterior periphery.
 16. A kneereplacement system for replacing at least a portion of a femur having asagittal plane and medial and lateral condylopatellar notch linestransverse to the sagittal plane comprising: a patellofemoral componentincluding an extension portion extending posteriorly from a recess abouta periphery of an intermediate portion and along a lateral portion andconfigured to overlie a portion of a lateral condyle of the femur abovean intercondylar notch and the lateral condylopatellar notch line of thefemur, the extension portion extending posteriorly from the recess ofthe intermediate portion being substantially planar and lying adjacentboth the intercondylar notch and lateral condylopatellar notch line andextending substantially parallel to the lateral condylopatellar notchline without contacting either of the intercondylar notch or the lateralcondylopatellar notch line of the femur when the patellofemoral implantis engaged to the femur, the patellofemoral component further includinga medial portion adjacent to the intermediate portion and configured tocover at least a medial portion of the femur, the medial portion lyingadjacent both the intercondylar notch and the medial condylopatellarnotch line without contacting either of the intercondylar notch or themedial condylopatellar notch line of the femur when the patellofemoralcomponent is engaged to the femur; and a condylar implant including arecessed portion opposed to the extension portion of the patellofemoralcomponent when the condylar portion is engaged to a condyle of thefemur, the recessed portion located anteriorly to the lateralcondylopatellar notch line of the femur.
 17. The knee replacement systemof claim 16, wherein the extension portion extends posteriorly from aposterior periphery of the patellofemoral component towards the lateralcondylopatellar notch line of the femur without contacting the lateralcondylopatellar notch line.
 18. The knee replacement system of claim 16,wherein the lateral portion has a first posterior periphery, theintermediate portion has a second posterior periphery, a medial portionhas a third posterior periphery, and the extension portion is located ata junction between the first and second posterior peripheries.
 19. Theknee replacement system of claim 18, wherein the extension portionprotrudes posteriorly from the junction as a nub portion.
 20. The kneereplacement system of claim 18, wherein the extension portion protrudesposteriorly from the junction along a substantial portion of the firstposterior periphery.